Cost-effectiveness of the Strategies for Surveillance of Antimicrobial-resistant Gonorrhea in the US: a Modelling Study

Background: The Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system to monitor the spread of antimicrobial-resistant (AMR) gonorrhea. Under GISP surveillance strategy, urethral isolates are utilized for monitoring the spread and the obtained estimates are used for informing the gonorrhea treatment guidelines. In 2017, the enhanced Gonococcal Isolate Surveillance Project (eGISP) was established which also includes the non-urethral isolates. Using eGISP estimates for informing the gonorrhea treatment guidelines is an alternative surveillance strategy that can be used. We aim to investigate cost-effectiveness of both strategies. Methods: We utilized our previously developed continuous-time agent-based model of gonorrhea transmission among the US men who have sex with men (MSM) population and calculated the total number of discounted quality-adjusted life years (QALYs) and total discounted costs over 35 years under GISP and eGISP surveillance strategy. We also evaluated cost-effectiveness of both surveillance strategies. Results: Under GISP surveillance strategy, $10.7M (95% uncertainty interval: $1.4M, $27.3M) were saved and 119.9 (12.9, 354.4) QALYs were gained over 35 years compared to no surveillance in the simulated cohort of 10,000 US MSM. Performing eGISP surveillance strategy instead would result in additional $29,282 (-$566,895, $700,595) saved and 0.25 (-6.7, 7.6) QALYs gained. Conclusion: The current GISP surveillance strategy significantly reduces the costs and increases the health benefits compared to no surveillance. However, switching from the current strategy to eGISP strategy is cost saving and should be considered in order to improve the population health and reduce the financial burden of gonorrhea.